Classification involves the categorization of relevant concepts for the purposes of systematic recording or analysis. The categorization is based on one or more logical rules. To this end WHO has developed reference classifications that can be used to describe the health state of a person at a particular point in time. Diseases and other related health problems, such as symptoms and injury, are classified in the International Classification of Diseases (ICD). A classification of diseases may be defined as a system of categories to which morbid entities are assigned according to established criteria. The ICD is used to translate diagnosis of diseases and other health problems from words into an alphanumeric code, which permits easy storage, retrieval and analysis of data.
The International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) and ICD-10-CM have been developed as a replacement of the International Classification of Diseases 9th Revision (ICD-9-CM). In ICD-9-CM, the methodology for assigning a code is the same for diagnosis code and procedure code. ICD-10-CM and ICD-10-PCS use different methodologies for assigning codes. ICD-10-CM defines the code set used to report inpatient and outpatient diagnoses. ICD-10-PCS defines the code set used to report inpatient procedures. The traditional ICD structure has been retained but an alphanumeric coding scheme replaces the previous numeric one. This provides a larger coding frame and leaves room for future revision without disruption of the numbering system.
Mapping from a source or a reference terminology to another version of the classification is not straightforward i.e. one source ICD code is linked to one or more target ICD codes. ICD-10 is much more specific, for diagnoses, there are 14,025 ICD-9-CM codes and 68,069 ICD-10-CM codes; and for procedures, there are 3,824 ICD-9-CM codes and 72,589 ICD-10-PCS. Therefore, one ICD-9-CM diagnosis code is represented by multiple ICD-10 diagnosis code or procedure codes and one ICD-10 Diagnosis Code or Procedure Code is represented by multiple ICD-9-CM codes.
In US, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention has created the national version of the General Equivalence Mappings (GEM) to ensure that consistency in national data is maintained. Oct. 1, 2013 is the compliance date for implementation of ICD-10 for all covered entities. Mapping from one ICD version to another may give multiple codes rather than a mirror image or a single code. The GEMs can be used by anyone who wants to convert coded data, including, but not limited to, payers, providers, medical researchers, informatics professionals, coding professionals, organizations. For example, in coding individual claims, it will be more efficient and accurate to select the appropriate code(s) from the reference mapping by using associated medical record documentation.
Disclosed herein is a system which address the problem of multiple mappings of a source ICD code to a target ICD code by using an adaptive mechanism to automatically convert to a target ICD code with the help of accompanying data and associated rules.